Airsense 10 CA vs OA

[archangle]

First off, the AirSense 10 CPAP doesn't distinguish CA from OA.

My opinion is that if the machine calls it a CA, it probably IS a CA, unless you're awake at the time. It may report a CA as an OA, because you can have a closed airway at the same time as a central apnea.

Overall, I think the numbers are probably pretty good.

[Dreams of Green]

Here are my thoughts for what it's worth. I started treatment a few months ago. Even with cpap I was seeing some nights with over 10 AHI per hour, with a mix of about 50% OA and 50% CA. Now a few months later, I'm usually under 1 AHI per hour. My pressure is still identical to when I started. So what changed? Nothing, except I learned to sleep better with my CPAP. It can take a while.

Was I really experiencing 10 AHI when I started? Certainly possible, but it seems to me it's just as possible those were false flags because I was sleeping horribly and unsoundly and having a lot of semi-awake events that were interpreted as AHI. Or maybe it's even a mix of the two, I was having more AHI then, and also more false flags.

I'm certainly not telling anyone to ignore their readings, just the opposite, I'd monitor them closely and also report them to the doctor. In this case because the vast majority are CAs I'd probably do that sooner rather than later. I'm only saying I wouldn't get worked up about them and would keep working on therapy and see if they start to improve. Often they will, and I've seen a ton of people report that as they do. If they don't improve, I'd be persistent about having the doctor investigate them.

I should also mention that for me finding the right mask was also a huge part of my improvement and one of the things that helped me start to be able to sleep well and in turn see better measurements.

[PaytonA]

First off, the AirSense 10 CPAP doesn't distinguish CA from OA.

My opinion is that if the machine calls it a CA, it probably IS a CA, unless you're awake at the time. It may report an OA as a CA, because you can have a closed airway at the same time as a central apnea.

Overall, I think the numbers are probably pretty good.

Arch,

I think that you might have had a typo. I think it should have read,"It may report a CA as an OA because you can have a closed airway at the same time as a central apnea". The machine will detect the closed airway and call it an OA. At least that is what I think you were trying to say.

Best Regards,

PaytonA

[Inspired]

Here are my thoughts for what it's worth. I started treatment a few months ago. Even with cpap I was seeing some nights with over 10 AHI per hour, with a mix of about 50% OA and 50% CA. Now a few months later, I'm usually under 1 AHI per hour. My pressure is still identical to when I started. So what changed? Nothing, except I learned to sleep better with my CPAP. It can take a while.

Was I really experiencing 10 AHI when I started? Certainly possible, but it seems to me it's just as possible those were false flags because I was sleeping horribly and unsoundly and having a lot of semi-awake events that were interpreted as AHI. Or maybe it's even a mix of the two, I was having more AHI then, and also more false flags.

I'm certainly not telling anyone to ignore their readings, just the opposite, I'd monitor them closely and also report them to the doctor. In this case because the vast majority are CAs I'd probably do that sooner rather than later. I'm only saying I wouldn't get worked up about them and would keep working on therapy and see if they start to improve. Often they will, and I've seen a ton of people report that as they do. If they don't improve, I'd be persistent about having the doctor investigate them.

I should also mention that for me finding the right mask was also a huge part of my improvement and one of the things that helped me start to be able to sleep well and in turn see better measurements.

I am already seeing about 50% reduction in leaks with my new mask after just 2 days, so "tincture of time" will be my plan for a couple of weeks. Will see the MD in 10 days and discuss progress. Thanks for the feedback.

[archangle]

I think that you might have had a typo. I think it should have read,"It may report a CA as an OA because you can have a closed airway at the same time as a central apnea". The machine will detect the closed airway and call it an OA. At least that is what I think you were trying to say.

Best Regards,

PaytonA

Thanks for the correction. edited.

[vsheline]

I think that you might have had a typo. I think it should have read,"It may report a CA as an OA because you can have a closed airway at the same time as a central apnea". The machine will detect the closed airway and call it an OA. At least that is what I think you were trying to say.

Best Regards,

PaytonA

Thanks for the correction. edited.

On the other hand, if memory serves, we have also seen in at least one member's posted detailed data what looked like combo central plus obstructive apneas which were flagged as Centrals. This was maybe a year or two ago, and I don't remember which thread it was.

The start of the apneas (which is when Central Apnea Detection occurs) looked like classic central apnea (the envelope of the Flow waveform gradually gets smaller and goes to zero), but when apneas ended, instead of the Flow envelope building up gradually, the Flow waveform restarted suddenly with big recovery breaths, which is classic for obstructive apnea.

So it seemed like these apneas were examples of a central apnea transitioning into an obstructive apnea.

[DaveD]

All,

Thanks for the comments. I have posted a zipped version of my SD card at https://www.hightail.com/download/ZWJYYk...SHg3czhUQw.

A few notes on what I have done so far (lack of response from my doctor has me going down the DIY road with the help of this excellent forum):

I had a home study, showed AHI of 53. I then did a titration study at a sleep lab, pressure of 10cm seemed to do the trick with a nasal mask, but had air leakage into my eye courtesy of the DCR, so ordered a Fitlife Total Face mask, XL based on the template.

Started on January 3, did reasonably well for 2:30 at CPAP-10. Similar on 1/4, but got 8 hours in.
Went to Vegas for a few days, left the machine home. Sleep apnea is the least of my worries there
Back in NJ, 1/10 through 1/14 at CPAP-10, results not so good, worst night was AHI 49.
Tried APAP with top number of 12 from 1/16 to 1/18, some improvement in AHI, but lots of leakage. Ordered a size L mask based on some comments here.
Treaded water with APAP 6/8 from 1/19 through 1/21, waiting for the new mask.
Got the new mask on 1/22, went to APAP 8/12. Seems like I'm getting lots of CA events, which the machine does not react to (meaning that it does not turn up the pressure for CA events).
Went to CPAP 12 for 1/23 and 1/24, best numbers yet. Leakage still a PITA, I think that's mostly from rolling on my side. The Total Face mask hates that.
Went to CPAP 13 on 1/25 in an effort to improve the numbers, not really successful.

Maybe stay at CPAP 12 for a week or two and see what happens? Try 14?

[archangle]

That's some ugly data.

Not just in terms of being severe, but in being hard to decipher.

A few things I note:

On many of your exhale cycles, there's about a 3 Hz ripple. It has a pretty high amplitude and doesn't look like what the ResMed FOT pattern looks like. It looks like snoring, but snoring is usually during inhaling. There's something called catathrenia, but I don't know a lot about it.

You have a lot of "unclassified apnea." They're probably unclassified mostly due to high leak rate.

You have a fair number of obvious, 100% apneas of fairly long duration. Breathing is flatlined for 20 or 30 seconds. Not that they're terribly bad, but they are clear indications that a real apnea is happening, whether you call it obstructive or central.

Go to the events tab on the left in the daily view, click on obstructive or clear airway. Then click on the individual events and look at the flow rate waveforms. Some of them are classical "no breathing" events.

For instance, CA 23:31:45 01/21/16 shows clear no breathing for 22 seconds or so.

OA 02:18:52 01/21/16 also shows a clear indication of stopped breathing for 39 seconds.

Note that the OA above shows a little pulsing up and down that sort of looks like breathing effort, adding credence to the idea it's an OA.

Look at a half hour starting around 02:10 on 01/21/16. That regular pattern of apneas every minute or so is typical of central/mixed apnea, but isn't really that definitive.

You do need to fix your leaks.

I'm not sure I've got good advice on what to do, but that's a few of the things I observe about your data. Maybe more later.

[DaveD]

I will be trying a RemZzz tonight. Exhale ripple is a bit strange - I measured ~2.5Hz on the ripple and ~4Hz on the FOT. The ripple seems to precede apneas...

[DaveD]

Tried a sample RemZzz pad last night, epic fail (removed it at 1A). https://www.hightail.com/download/ZWJYYk...RTNMbjhUQw

I'm going to back down to CPAP 12 and see if I can get this leak stabilized. Two problems, I think. One is my tendency to roll onto my side, which the total face mask doesn't tolerate. Second is that my lower jaw is pulling back when I fall asleep, might try a boil and bite mouthguard to keep it in place. Sheesh.